Rad Onc Twitter

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A moment of silence for deleted1002574
The artist formerly known as @ROFallingDown, this thread's starter.
It's an unwieldy, ugly, beautiful, sensationalistic, informative, 7-headed Hydra of a thread that will go on ad infinitum in perpetuity ad nauseum.

Unofficially, and now officially?, SDN Rad Onc's greatest thread of all time.

RIP ROFallingDown
 
scarbrtj said:
A moment of silence for deleted1002574
The artist formerly known as @ROFallingDown, this thread's starter.
It's an unwieldy, ugly, beautiful, sensationalistic, informative, 7-headed Hydra of a thread that will go on ad infinitum in perpetuity ad nauseum.

Unofficially, and now officially?, SDN Rad Onc's greatest thread of all time.

RIP ROFallingDown
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ROFD deleted his account?
 
RadOncDoc21 said:
To be fair, if it works, it will definitely be a game changer in regards to people respecting our field.
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We’re going to know if it works from a single arm 5 patient study? What can possible be concluded from this? What a waste of resources and placing staff at risk.


Sent from my iPhone using SDN
 
scarbrtj said:
First, on record as respecting the Khan.
Second, many of the responses are petty and goofy and for lack of better word very non-self-aware.
However, med students and aspiring rad onc'ers... here be the Life of the Rad Onc. It is a lonely life. It is a hard life. People who aren't rad oncs will attack and judge and dismiss. And people who are rad oncs will tend to do that to you twice as hard!
They have a saying in the UK, "Don't put your head above the parapet." You can try doing so in business, law, the personal fitness industry, professional soccer, orthopedic surgery, and a few other things I can think of. BUT NEVER TRY TO DO THIS IN RAD ONC.

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Wow, your quote looks even better as this Tweet was deleted lol
 
I don't think that it's such an absurd idea but holy crap does his tweet show a lack of self awareness. He just comes across as a snake oil salesman saying things like this trial "promises to improve patient outcomes" and "i suspect that this will be a game changer." He deserved every bit of the roasting that he got. Not because of the trial itself (I haven't read the protocol and don't care to) but because of the way he tried to sell it.

Tweets like these are how vaccines cause autism.
 
RSAOaky said:
I don't think that it's such an absurd idea but holy crap does his tweet show a lack of self awareness. He just comes across as a snake oil salesman saying things like this trial "promises to improve patient outcomes" and "i suspect that this will be a game changer." He deserved every bit of the roasting that he got. Not because of the trial itself (I haven't read the protocol and don't care to) but because of the way he tried to sell it.

Tweets like these are how vaccines cause autism.
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The Use of Superlatives in Cancer Research
Matthew V. Abola; Vinay Prasad, MD, MPH

cld150012t1.png
 
frijoles said:
We’re going to know if it works from a single arm 5 patient study? What can possible be concluded from this? What a waste of resources and placing staff at risk.


Sent from my iPhone using SDN
Click to expand...

That quote has to be taken in context with the rest of my statement. I offer very little support to what he’s doing but I don’t think he’s wrong for trying something out. “If” it works out, could be a great thing. I doubt it but I def am not in a position to know any better.
 
RadOncDoc21 said:
That quote has to be taken in context with the rest of my statement. I offer very little support to what he’s doing but I don’t think he’s wrong for trying something out. “If” it works out, could be a great thing. I doubt it but I def am not in a position to know any better.
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That’s fair! I’m just trying to wrap my head around what can possibly be learned from radiating the lungs of 5 critically ill covid pts? Even if none progress to MV have no way of knowing if the intervention did anything. If they all die do we conclude the intervention is not safe? I know people are desperate for treatments but....


Sent from my iPhone using SDN
 
RSAOaky said:
I don't think that it's such an absurd idea but holy crap does his tweet show a lack of self awareness. He just comes across as a snake oil salesman saying things like this trial "promises to improve patient outcomes" and "i suspect that this will be a game changer." He deserved every bit of the roasting that he got. Not because of the trial itself (I haven't read the protocol and don't care to) but because of the way he tried to sell it.

Tweets like these are how vaccines cause autism.
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This sealed the deal imo
 

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Chartreuse Wombat said:
Would like to see the data. Chinese study in Lancet was negative. Is this the beginning of the modern day "Space Race" with CHina playing the part of USSR. Propaganda awaited.
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I think the idea is that it is attenuating the virus and slowing down replication? People are looking for anything at this point...
 
scarbrtj said:
The Use of Superlatives in Cancer Research
Matthew V. Abola; Vinay Prasad, MD, MPH

cld150012t1.png
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maybe RO would be in a slightly better place if our own people believed in the GAME CHANGER goodness of our own modality rather than no radiation always being better. Some of the most anti XRT people i have met are actually fellow rad oncs. Tells you something about where we are today
 
thecarbonionangle said:
maybe RO would be in a slightly better place if our own people believed in the GAME CHANGER goodness of our own modality rather than no radiation always being better. Some of the most anti XRT people i have met are actually fellow rad oncs. Tells you something about where we are today
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How many people are fine with giving 5 years of AI therapy but squawk over 3 weeks of xrt? Just one of many examples...
 
medgator said:
How many people are fine with giving 5 years of AI therapy but squawk over 3 weeks of xrt? Just one of many examples...
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This one probably drives me nuts the most. I have lost count of the number of people who have discontinued their AI due to arthralgias but made it through radiation without batting an eye. I'm not sure I can even remember a single patient that couldn't complete their course of adjuvant RT.
 
medgator said:
How many people are fine with giving 5 years of AI therapy but squawk over 3 weeks of xrt? Just one of many examples...
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how many people? not that many.

the benefit of these 5 fraction courses are that a lot of people are basically treating everyone know. low grade DCIS or old breast cancer patient? observation versus 5 weeks of RT was a question. Now that it's 5 fractions, no reason to equivocate.

also don't know your experience, but you seem to bring this up a TON - did you train with breast rad oncs who were into observation? most don't.

if you're not getting the consults at all in the first place, that's a different story, and is something you should hash out with your referrings. In my experience, breast surgeons LOVE short course 5 fraction RT for their old ladies.
 
PhotonBomb said:
how many people? not that many.

the benefit of these 5 fraction courses are that a lot of people are basically treating everyone know. low grade DCIS or old breast cancer patient? observation versus 5 weeks of RT was a question. Now that it's 5 fractions, no reason to equivocate.

also don't know your experience, but you seem to bring this up a TON - did you train with breast rad oncs who were into observation? most don't.

if you're not getting the consults at all in the first place, that's a different story, and is something you should hash out with your referrings. In my experience, breast surgeons LOVE short course 5 fraction RT for their old ladies.
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I'm talking about med oncs mainly these days. Get with the program and try living in the real world. Definitely some rad oncs out there that think that way also, however and, I'm not the only one who has seen that, clearly
 
medgator said:
I'm talking about med oncs too dude. Get with the program and try living in the real world. Definitely some rad oncs out there that think that way also
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almost said breast surgeons and med oncs. same thing. they both love the shorter courses. it's a much easier proposition to treat everyone when the courses and fields are smaller.

sorry that you don't have a good relationship with your referrings.

gotta grind man.

feel bad for you.
 
PhotonBomb said:
almost said breast surgeons and med oncs. same thing.

sorry that you don't have a good relationship with your referrings.

gotta grind man.

feel bad for you.
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I get referrals from breast surgeons who get it. Obviously it's not foolproof and things are the way they are if patients filter through MO.

The bottom line is that our own specialty should advocate for xrt more in that argument and clearly many don't see that
 
medgator said:
I get referrals from breast surgeons who get it. Obviously it's not foolproof and things are the way they are if patients filter through MO.

The bottom line is that our own specialty should advocate for xrt more in that argument and clearly many don't see that
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Again, that is my point. I don't think breast rad oncs are advocating against RT. Literally there was stuff on social media yesterday about treating with RT alone instead of hormonal therapy alone from academic breast rad oncs.

I think you just like to believe that people are out to get you.

As a PP rad onc, I used the shorter courses as a way to get more patients than I ever treated before.
 
PhotonBomb said:
how many people? not that many.

the benefit of these 5 fraction courses are that a lot of people are basically treating everyone know. low grade DCIS or old breast cancer patient? observation versus 5 weeks of RT was a question. Now that it's 5 fractions, no reason to equivocate.

also don't know your experience, but you seem to bring this up a TON - did you train with breast rad oncs who were into observation? most don't.

if you're not getting the consults at all in the first place, that's a different story, and is something you should hash out with your referrings. In my experience, breast surgeons LOVE short course 5 fraction RT for their old ladies.
Click to expand...

I would agree that its not really common if you have a good relationship in the community. Its only happened to me once in my short career. At tumor board the Med Onc said "Well she's 70 and its an early stage, small tumor so her benefit from RT is small. She still wanted to go through with it but when I explained to her all that was entailed... she agreed she didn't need it. The risk is low without RT.... right Dr. dieABRdie?"

I calmly explained "Yes... the risk is low... unless she discontinues her hormonal therapy. Then the risk is unacceptable. If she wants the lowest risk possible she should probably at least be offered it."

I saw her next week.
 
dieABRdie said:
I would agree that its not really common if you have a good relationship in the community. Its only happened to me once in my short career. At tumor board the Med Onc said "Well she's 70 and its an early stage, small tumor so her benefit from RT is small. She still wanted to go through with it but when I explained to her all that was entailed... she agreed she didn't need it. The risk is low without RT.... right Dr. dieABRdie?"

I calmly explained "Yes... the risk is low... unless she discontinues her hormonal therapy. Then the risk is unacceptable. If she wants the lowest risk possible she should probably at least be offered it."

I saw her next week.
Click to expand...

Good call!

I’ve started being more aggressive these days and letting the docs know where the data stands. I came into a practice that had limited referrals so I figured sucking up wasn’t going to make a difference in the rest of the community. If anything, there is a feeling of relief which I wish I would have started doing sooner. All of my older established partners didn’t care what was said about radiation and what it does.

Bottom line, we need to do more in our field and not focus on how we have to get referrals.
 
dieABRdie said:
I would agree that its not really common if you have a good relationship in the community. Its only happened to me once in my short career. At tumor board the Med Onc said "Well she's 70 and its an early stage, small tumor so her benefit from RT is small. She still wanted to go through with it but when I explained to her all that was entailed... she agreed she didn't need it. The risk is low without RT.... right Dr. dieABRdie?"

I calmly explained "Yes... the risk is low... unless she discontinues her hormonal therapy. Then the risk is unacceptable. If she wants the lowest risk possible she should probably at least be offered it."

I saw her next week.
Click to expand...

i don’t understand why the options are hormone therapy with or without radiation in these patients rather than hormone therapy OR radiation. If your options are 5-10 years of a pill with 33% compliance and pretty bad side effects that are often undersold Vs. 1 or 3 or even 5 weeks of radiation it seems like a no brainer...
 
The argument is that there is at least SOME systemic risk in low risk invasive patients. Systemic failure is what will kill a 70+ year old from breast cancer, not in breast recurrence. Antiestrogen therapy is a systemic treatment. Radiation is not.
 
PhotonBomb said:
the benefit of these 5 fraction courses are that a lot of people are basically treating everyone now...
In my experience, breast surgeons LOVE short course 5 fraction RT for their old ladies.
Click to expand...

dieABRdie said:
"Well she's 70 and its an early stage, small tumor so her benefit from RT is small. She still wanted to go through with it but when I explained to her all that was entailed... she agreed she didn't need it. The risk is low without RT.... right Dr. dieABRdie?"
Click to expand...
Maybe, just maybe, we should be a little more intellectually honest and 1) admit that there is a real data-driven push not to give RT to the "old ladies" and 2) pushing for RT where 5-fx is a "reasonable option" in old ladies may itself constitute a shady practice. Maybe not shady in our arena, but others outside our arena may view it as shady. Up to and including OIG types. You think I kid; it's entirely possible OIG could see ubiquitous ("a lot of people are basically treating everyone now") RT for Stage I ER+ br CA patients as an overreach. And if OIG may not see it that way, CMS might; if the right one don't get you then the left one will. Full disclosure: yes sometimes I give the RT to the old ladies. But like Marvell said "At my back I always hear time's winged chariot hurrying near."

PRIME II and the Omission of Radiation Therapy in Low-Risk, Elderly Patients Undergoing Breast Conservation: The Time Has Come
 
Yes scarb - I agree that if we are being intellectually honest, RT reducting a 10-year risk of LR from 10% to 2% in CALGB trial definitely raises the question of 'why radiate for 8% improvment in LC when LC is likely not that important in this population of old ladies'? Non-rad oncs DEF have a point if they raise this question

However, when the argument shifts to "I can treat you 5 times to a small part of the breast' (my preference in my practice), the 'cost' to the patient in terms of time and toxicity becomes so low that the cost benefit ratio makes a lot more sense to just treat?
 
PhotonBomb said:
Yes scarb - I agree that if we are being intellectually honest, RT reducting a 10-year risk of LR from 10% to 2% in CALGB trial definitely raises the question of 'why radiate for 8% improvment in LC when LC is likely not that important in this population of old ladies'? Non-rad oncs DEF have a point if they raise this question

However, when the argument shifts to "I can treat you 5 times to a small part of the breast' (my preference in my practice), the 'cost' to the patient in terms of time and toxicity becomes so low that the cost benefit ratio makes a lot more sense to just treat?
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It's a reasonable argument. However I have seen many reasonable arguments get kicked to the curb in my day!
 
RSAOaky said:
i don’t understand why the options are hormone therapy with or without radiation in these patients rather than hormone therapy OR radiation. If your options are 5-10 years of a pill with 33% compliance and pretty bad side effects that are often undersold Vs. 1 or 3 or even 5 weeks of radiation it seems like a no brainer...
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I just worry that if it's presented as HT vs RT, the med oncs might get defensive/territorial if no one chooses HT.
 
w00tz said:
I just worry that if it's presented as HT vs RT, the med oncs might get defensive/territorial if no one chooses HT.
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yes.

and also, systemic therapy serves a different purpose, and if it's 'hormonal therapy until they can't tolerate it' as well as easy radiation, thats a pretty good approach for most early stage patients IMO
 
Is anybody noticing an increase of these “survey” requests. Will only take 15 min thanks. One one side i want to support a fellow resident getting a pub, but it seems more of this “research” is being done. What are your thoughts, beehive?
 
thecarbonionangle said:
Is anybody noticing an increase of these “survey” requests. Will only take 15 min thanks. One one side i want to support a fellow resident getting a pub, but it seems more of this “research” is being done. What are your thoughts, beehive?
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It's just getting worse and worse. With the internet and centralized databases of everyone's information, it takes very little effort to churn out this "research". Not just a RadOnc problem, it's a Medicine problem. As everyone "learns the game" people start working on their CVs earlier and earlier and to an increasing degree. Look at your average medical school applicant now vs 20 years ago. It's ridiculous. With most programs adapting to the mandatory 4th year of residency in the late 90s by turning it into a research year, RadOnc just got (and maintained) a head start on the rest of the gang.
 
RadOncMegatron said:
I would take the survey, if they could guarantee no pub in a medical journal, but ASTRO blog post, Twitter, or SDN is ok.

Being displayed in a major publication, gives this "research" unnecessary prestige. It should not pass review in my opinion.
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ya but most of them is clearly for a pub. You get all the data do a quick write up boom!

is this “the game” now?
 
thecarbonionangle said:
Is anybody noticing an increase of these “survey” requests. Will only take 15 min thanks. One one side i want to support a fellow resident getting a pub, but it seems more of this “research” is being done. What are your thoughts, beehive?
Click to expand...

I received 2 surveys this year, which is down from in the past IMO thankfully lol

1) Minnesota on COVID impact on rad onc
2) ARRO survey on each program
 
radoncdoc16 said:
I received 2 surveys this year, which is down from in the past IMO thankfully lol

1) Minnesota on COVID impact on rad onc
2) ARRO survey on each program
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ARRO survey is fine, IMO. I see this as a QA exercise for an organization that is advocating for residents. They have had a track record of advocating, particularly in the physics/radbio fiasco. I will be happy to spend as much time necessarily to give them the data they need.

The Minnesota resident survey on COVID impact is frankly shameful. Such research does nothing to improve patient outcomes, nor does it improve our field in any way. But it will be a Red Journal publication in a few months and a line in this resident's CV, sigh. Sent immediately to my spam box
 
beamseyeview said:
ARRO survey is fine, IMO. I see this as a QA exercise for an organization that is advocating for residents. They have had a track record of advocating, particularly in the physics/radbio fiasco. I will be happy to spend as much time necessarily to give them the data they need.

The Minnesota resident survey on COVID impact is frankly shameful. Such research does nothing to improve patient outcomes, nor does it improve our field in any way. But it will be a Red Journal publication in a few months and a line in this resident's CV, sigh. Sent immediately to my spam box
Click to expand...

not exactly a “happening place.” Familiar with program. To put it into context, look up GFunk’s review of the place from when he was applying to residency. The same review applied a few years ago. Doubt it has changed.
 
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